Eligibility Manager

Summary

Join WelbeHealth as the Manager, Eligibility and play a pivotal role in ensuring the smooth operation of Medicaid and Medicare coverage for our senior population. You will lead the Eligibility team, maintain uninterrupted participant coverage, safeguard revenue, and uphold compliance standards. This leadership position requires collaboration with internal and external stakeholders to ensure accurate and integrated participant data. You will leverage data analytics and regulatory knowledge to mitigate risks and communicate effectively with key stakeholders. The role involves overseeing participant data integrity, monitoring revenue impact, and liaising with government agencies. This is a remote opportunity based in California with some travel.

Requirements

• Bachelor’s Degree in relevant field
• Minimum of five (5) years’ experience working in healthcare or social services administration
• Minimum of three (3) years of experience interacting with local government Medicaid or Social Security agencies
• Minimum of one (1) year of experience working with Medicare eligibility and Center for Medicare and Medicaid Services
• Two (2) years’ supervisory experience with demonstrated ability to mentor and develop team members
• Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects

Responsibilities

• Lead our Eligibility team to ensure our participants maintain eligibility for PACE services through proactive management including but not limited to establishing strategies, tools and management processes that prevent eligibility discrepancies
• Leverage advanced data analytics and a deep understanding of regulatory requirements, to proactively identify and mitigate risks pertaining to participant eligibility; ensure reporting accuracy by supervising the verification of eligibility data in key reports, such as encounter and prescription drug event reporting
• Oversee participant demographic, eligibility and enrollment data integrity across all Welbe systems
• Monitor revenue impact by directing the analysis of eligibility data, identifying potential financial risks, and ensuring that these risks and outcomes are communicated to finance teams and local programs
• Effectively communicate risks and outcomes to key stakeholders while engaging in a collaborative process that transforms complex data into actionable insights that result in timely decision-making
• Coordinate with local market leaders by directing efforts to identify and prioritize high impact discrepancies, ensuring the team executes corrective actions efficiently and effectively
• Liaise with county and state agencies and other governmental agencies to verify continuous eligibility for Welbe participants and ensuring participants’ Medicaid and Medicare coverage is correctly attributed

Preferred Qualifications

Experience working in a larger scale company environment

Benefits

• Health Coverage on Day 1
• Paid Parental Leave
• 401K Match
• 17 days of paid time off in year one
• 12 company holidays & 6 sick days
• Career path advancement and leadership opportunities